Talking Therapy: What It Actually Is, and What It Is Not
Talking Therapy: What It Actually Is, and What It Is Not
When I suggest therapy, I can usually tell within two seconds what picture has appeared in the person’s head.
A couch. A quiet foreigner asking about their childhood. Years of it. Something expensive that happens to people in films.
Or the other picture, which is more common here and does more damage: that therapy is just talking, and they already have a wife, a brother and three friends they can talk to, so what exactly would they be paying for?
Both pictures are wrong, and the second one is the reason a lot of people in this city stay unwell longer than they need to.
The short answer
Talking therapy is a structured course of conversations with a trained person, aimed at a specific problem, usually with a defined number of sessions and a plan. It is not advice, and it is not friendship for a fee.
For milder depression and for most anxiety problems, structured therapies stand up well against medication in research. For more severe illness, the evidence generally supports doing both rather than choosing. And for a few conditions — obsessive-compulsive disorder in particular — a specific type of therapy is not optional extra polish, it is a core part of treatment.
What it is not
— It is not someone telling you what to do. If you are being given instructions about your marriage in session two, that is not therapy.
— It is not a lifetime commitment. Most structured therapies are counted in weeks.
— It is not only for the severely ill. Quite the opposite — it often works best earlier.
— It is not talking about your childhood, unless the childhood turns out to be the point. Most sessions are about this week.
— It is not a softer option chosen by people who are afraid of tablets. Done properly, it is hard work, and people find it tiring.
The main kinds, in plain words
There are dozens of named therapies. These are the ones you will actually encounter.
— Cognitive behavioural therapy. Works on the loop between how you think, what you do, and how you feel. Practical, structured, usually the first thing offered for depression and anxiety.
— Behavioural activation. Sounds too simple to work — rebuilding activity and routine, deliberately, in a planned order. It works, and it is often the part that moves first in depression.
— Exposure and response prevention. The specific therapy for OCD. It involves facing the fear without performing the ritual, gradually, with support. Unpleasant to describe, and it is the thing that helps.
— Family therapy and family interventions. The unwell person is not treated in isolation from the house they live in. Particularly useful where there is a long-term illness at home.
— Motivational work, in addiction. Not lecturing someone into stopping. A method for helping a person resolve their own genuine ambivalence — which every person with an addiction has, whatever they say out loud.
— Supportive therapy. Regular, steady, non-technical. Underrated, and for some people the right answer.
— Psychodynamic therapy. The longer, deeper kind, working on recurring patterns in relationships. Slower, and not the first choice for an acute crisis.
You do not need to choose between these. Naming the problem is the job; the person you see will suggest the method.
What a session is actually like
Around forty-five minutes to an hour. Usually once a week at the start. Two chairs, no couch. In the first session or two, the therapist takes a history and, more importantly, agrees with you on what you are working on — written down, in specific terms.
“I want to be happy” is not a goal anyone can work with. “I want to be able to get to the shop and back without turning around at the corner” is.
And then there is the part that surprises people: homework. Most structured therapies ask you to do something between sessions — record something, try something, notice something. The people who do it improve faster than the people who do not. That is the least mysterious finding in this whole field.
How many sessions
For the structured therapies, commonly somewhere between eight and twenty. For OCD or trauma work, it can be longer. For psychodynamic work, longer again and less fixed.
If nobody has told you roughly how long, ask in the first session. A therapist working to a method will have an answer. It is a fair question and a revealing one.
Therapy or medicine — the question is asked wrong
People come to me having already decided this is a moral contest. Medicine is the weak option, or the dangerous one, and therapy is the pure one. Or the reverse — therapy is for people with nothing really wrong, and a real illness needs a real tablet.
Neither. They do different jobs, and quite often they do them at the same time.
Roughly: medication tends to move the biological floor — sleep, appetite, energy, the physical weight of the illness. Therapy tends to change what you do with the illness and what happens after it lifts. Which is why, in recurrent conditions, therapy is often the part that reduces the chance of the next episode rather than the current one.
There is also a practical truth nobody says. When someone is so unwell they cannot follow a conversation or read a page, starting with therapy alone is setting them up to fail at it. Order matters. That is a clinical judgement, not a philosophy.
Who is qualified to do this in India
This section will save some readers money, so I am going to be direct.
Clinical psychologists in India are registered with the Rehabilitation Council of India and hold a recognised qualification in clinical psychology. Psychiatrists are medically qualified and registered with a State Medical Council; some also practise therapy. Psychiatric social workers have their own training and their own real expertise, particularly with families.
The word “counsellor”, on the other hand, is not a protected title in India. There is no single register, no minimum qualification attached to the word itself. Some people using it are excellent and thoroughly trained. Some completed a certificate online over a weekend. The word will not tell you which.
So ask. What is your qualification, where did you train, and are you registered anywhere? A properly trained person answers that in one sentence without taking offence. Hesitation is your answer.
I am not saying this to run down anyone’s practice. I am saying it because a person in distress is the easiest person in the world to sell something to, and they deserve to know what the words on the signboard do and do not guarantee.
Cost, time, and the things that actually stop people
Therapy generally costs more in total than medication over the same period, and it costs time — a weekly slot, travel, and possibly leave from work. For a lot of families in Nashik, that is the real barrier, not stigma.
Worth knowing: government medical colleges and district hospitals do provide psychological services, and the Tele-MANAS line offers counselling support free, in Marathi, at any hour. That is not the same as a full course of structured therapy, but it is a real starting point for someone who cannot pay privately.
If cost is the problem, say so to your doctor rather than disappearing. There is usually a version of a plan that fits — fewer sessions, a different sequence, a referral you did not know about. What there is no plan for is the patient who stops coming and never says why.
Online therapy
It works, and the research supports it for common problems. It has made therapy reachable for people who would otherwise never have started.
Two cautions. It suits some situations poorly — an acute crisis, significant risk, or a house with no private room where you cannot speak freely. And the platform you use should still tell you the therapist’s qualification and registration. Same question, same right to ask.
How to tell if it is working
Not by whether the sessions feel good. Some of the most useful sessions are uncomfortable, and some very pleasant ones go nowhere for months.
Better signs: you can name what you are working on. Something you avoided is now something you do, even badly. The gap between a bad thought and a bad evening is getting longer. Somebody at home has noticed.
If after four to six sessions you have no sense of direction at all, that is a conversation to have with the therapist — out loud, in the room. A good one will welcome it. And if it still does not fit after that, changing therapist is allowed. The relationship between the two of you is not a soft extra; it is one of the more reliable predictors of whether this works.
A word about language
Therapy in a language you do not think in is therapy with the volume turned down.
People here often reach for English because they assume it is the professional language, and then spend the session translating themselves. If you think in Marathi, look for someone you can do this in Marathi with. It is a harder thing to find, and it is worth the trouble.
One case
A young woman came in with panic attacks. She had been given a tablet elsewhere; it had helped, and she had also quietly stopped going anywhere on her own. Home, office, home. Her world had shrunk so gradually that nobody in the family had registered it, including her.
The medicine had done its job on the attacks. It had done nothing about the avoidance, because avoidance is a habit, and habits do not respond to chemistry.
What changed it was twelve weeks of ordinary, unglamorous, structured work. A list. One thing at a time, in a deliberate order, starting with something almost insultingly small. She hated the first month. The last time I saw her she mentioned, without treating it as news, that she had driven to Pune.
This account is fictional and composite. It is built from patterns seen in practice and does not describe any individual patient.
What to do next
— Write down the one thing you want to be different in three months. Specific and small. That sentence is where therapy starts.
— Ask whoever you consult which type of therapy fits your problem, and roughly how many sessions.
— Ask the therapist their qualification and registration before the first session, not after the fourth.
— Choose the language you think in, not the one you think you should use.
— Plan to do the homework. It is the part that separates people who improve from people who attend.
— If cost is the obstacle, say it plainly rather than dropping out. There is almost always another route.
Sources
- Indian Psychiatric Society — Clinical Practice Guidelines, on psychological interventions in depressive, anxiety and obsessive-compulsive disorders.
- World Health Organization — mhGAP Intervention Guide, on brief psychological interventions and when to combine them with medication.
- Rehabilitation Council of India Act, 1992 — registration of clinical psychologists in India.
- Ministry of Health and Family Welfare, Government of India.
- Tele-MANAS, national tele mental health programme.
This article is for education only. It is not a substitute for consultation with a qualified doctor, and it is not a diagnosis or a treatment plan for any individual reader.
If you or someone you know is in distress, free and confidential help is available. Tele-MANAS: 14416 or 1800-891-4416, 24 hours, in Marathi and other Indian languages.
About the author: Dr. Muktesh Daund is a Consultant Psychiatrist and De-addiction Specialist (MBBS, DNB Psychiatry) practising in Nashik, Maharashtra since 2016.